乳腺癌（全英文版）.ppt

NursingCareofthePatientswithBreastCancer Section AnatomicandPhysiologicOverview Apartoftheexternalfemalereproductivesystem Inmalesandfemales thebreastsarethesameuntilpuberty 青春期 Externalstructures nipple areola 乳晕 andMontgomerytubercles 蒙哥马利结节 Section2 BreastExamination BreastExamination Visualinspection tonoteanychangesincontour 轮廓 ortexture 皮肤肌理 Manualinspection Palpation tonoteanyunusuallumpsorthicknesses Palpation PalpationoflumpsPalpationoflymphPalpationofareola Inasupineposition 仰卧 palpatedfromtheouteredgeofthebreasttothenipple3 describedbyitslocation size shape consistency borderdelineation andmobility Palpationoflumps Palpationoflymph Palpationoftheaxillaryandclavicularareaswithpatientseated Normally thelymphnodesarenotpalpable Iftheyareenlarged thesize location mobility consistencyandtendernessarenoted Palpationofareola Theareolaaroundthenippleisgentlycompressedtodetectanydischargeorsecretion Cytologyexamination细胞学检查Imagingprograms Mammography Biopsy Specialexaminations Section3 Breastcancer Definition Breastcancerisamalignantgrowththatbeginsinthetissuesofthebreast Increasingage 50PersonalorfamilyhistoryofbreastcancerNeverhadchildrenHadtheirfirstchild 30NeverbreastfedHistoryoffibrocysticbreastdiseaseEarlymenarche 10Latemenopause 55Obesity consumeahigh fatdietSmokingandalcoholintake Etiology Symptoms Signs EarlyfindingsLaterfindingsLatefindings Earlyfindings Breastmass single painless firm nontender thickeninginthebreastwithirregularborders upper outerquadrantofthebreastMorecommonintheleftbreast Laterfindings AunilateralchangeinthesizeorshapeofthebreastSkinornippleretraction 乳头内陷 AbnormaldischargefromthebreastAnorange peelappearanceoftheskinDimplingoftheskin aconditioncausedbyswellingthatresultsfromobstructedlymphaticcirculationinthedermallayer 真皮层 Orange peelappearance Dimplingoftheskin thebreasttissueortumourattachingtotheskinortheunderlyingmusclemass whichdoesnotpermitmovement Latefindings Bonepain weightloss andskinulceration edemaofarm Bone lung liver brain orotherdistantmetastases RadiationtheapySurgeryHormonalTherapyChemotherapy Treatment FormsofSurgery Lumpectomy 乳房肿瘤切除术 Modifiedmastectomy 乳房癌改良根治术 Standardradicalmastectomy 乳房癌标准根治术 Extendedradicalmastectomy 乳房癌扩大根治术 Simplemastectomy 乳房单纯切除术 Lumpectomy 乳房肿瘤切除术 Alumpectomyissurgicalremovalofthecancerousmass Modifiedmastectomy 乳房癌改良根治术 totalmastectomy axillarydissection Standardradicalmastectomy 乳房癌标准根治术 entirebreast axillarynodes pectoralmuscle Modifiedmastectomy Standardradicalmastectomy preservationofthepectoralismajormuscle Extendedradicalmastectomy 乳房癌扩大根治术 Asimplemastectomy 乳房单纯切除术 removingtheentirebreast leavingtheaxillarynodesintact Section4 Nursingprocess 1 Reducingfearandanxiety2 Explainingthecancerandtreatment3 Promotingdecision makingability4 Takinghigh nutritionalfoods Preoperativecare 1 Reducingfearandanxiety Changesoffeelings心理变化Relaxedatmosphere轻松氛围 Bovinecommunications耐心交谈 Encouragethefamilytoparticipate家属参与 Successfulcases成功病例 2 Explainingthecancerandtreatment RelatingknowledgeDetailedexplanationsAbsorptionandfeedback Explaindiagnosticproceduresandtreatmentwhileperforming Givetimetoabsorbthesignificanceofthediagnosisandinformation CarefulguidanceandsupportivecounselingEncouragingthepatienttotakeonestepofthetreatmentprocessatatime 3 Promotingdecision makingability 4 Takinghigh nutritionalfoods Postoperativecare 1 Relievingpainanddiscomfort2 Maintainingskinintegrityandpreventinginfection3 Improvingskills4 Postmastectomyexercises Semi inclinepositionPainreliefEdemaofthearm Betreatedbyantibiotics heat rest moderateelevationoftheinvolvedarm 1 Relievingpainanddiscomfort DecreasetensionPromotecirculationPreventvenouscongestion Whyshouldweelevatetheaffectedarm 2 Maintainingskinintegrity preventinginfection Skinflapcare皮瓣护理Drainagecare引流护理Incisioncare手术切口护理 Chestbandage胸带 Color healingofthewoundsurface颜色 创面Circulationoftheaffectedarm患肢循环 Skinflapcare KeepeffectivesuctionPreventobstructionSterilization Drainagecare ObservationsRecordRemove拔管 BeinspectedforbleedingTheextentofdrainage Placedfor7to10days 30ml 24h Symptoms signsofinfection Incisioncare Oral intravenousantibioticsAdrydressingLotionsorcreams Privacyisaconsiderationwhenassistingthewomantoviewherincision 保护隐私 Breastreconstruction乳房重建术 Goodinterpersonalcommunicationalskills良好的人际沟通 3 Improvingcopingskills Ambulation activemotionofthearmandshoulderontheoperatedside 早期下床活动及患肢的主动运动 3timesdailyfor20minutesatatime每日3次 每次20分钟 4 Postmastectomyexercises Instructions HowtodoB S E Propertime 5to7daysaftermenses Step1 Check 1 Breaststhataretheirusualsize shape andcolor 2 Breaststhatareevenlyshapedwithoutvisibledistortionorswelling Clasphandsbehindheadandpresshandsforward watchingforchangesintheshapeorcontourofbreasts Step2 Presshandsonhipsandbendtowardmirrorwhilepullingshouldersandelbowsforward noteanychangeinthecontourofyourbreasts Step3 Gentlysqueezeeachnipple loadingfordischarge Step4 1 Raiseonearmandusefingersofotherhandtocheckbreastforlumpsormassesunderskin Useapatternofmotion circular up and down etc tocoverentirebreast 2 Repeatonyourrightbreast Step5 1 Lyingdown Lieflatonyourbackwithyourleftarmoveryourheadandapillowunderyourleftshoulder thispositionflattensyourbreastandmakesiteasiertocheck 2 repeatStep43 Repeatonyourrightbreast 53 Case Misswang 3